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Individual
DR. KENNETH DEMAREST
Active
Individual
DR. KENNETH DEMAREST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
001360
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001360
STATE LICENSE #
CT
01
—
050001360CT04
BCBS
CT
01
—
1034337
ASHN
CT
01
—
10450156
CAQH
CT
01
—
1289267
AETNA HMO#
CT
01
—
7163301
AETNA NON HMO/PPO#
CT
01
—
CT0847
LANDMARK/HEALTH NET
CT
Enumeration date
07/28/2006
Last updated
07/08/2007
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